Mechanisms of glomerular hyperfiltration in diabetes mellitus
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- Section Editors
- Richard J Glassock, MD, MACP
Richard J Glassock, MD, MACP
- Editor-in-Chief — Nephrology
- Section Editor — Glomerular Diseases
- Emeritus Professor
- The David Geffen School of Medicine at UCLA
- David M Nathan, MD
David M Nathan, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Diabetes Mellitus
- Professor of Medicine
- Harvard Medical School
A 25 to 50 percent elevation in the glomerular filtration rate (GFR) is seen early in the course in up to one-half of patients with type 1 diabetes mellitus , an abnormality that is exaggerated after ingestion of a protein load . Glomerular hypertrophy and increased renal size typically accompany the rise in GFR .
Hyperfiltration also occurs early in the course of type 1 and type 2 diabetes [3,4]. In an original report of 110 newly diagnosed patients with type 2 diabetes mellitus, for example, the GFR was above 140 mL/min in 16 percent and more than two standard deviations above the mean of a control population in 45 percent . The prevalence of hyperfiltration may be lower in the era of more aggressive glucose control. A later study of 93 newly diagnosed patients, for example, found that 17 percent had a GFR that was more than two standard deviations above the mean of a control population .
The degree of hyperfiltration and the course of the GFR in type 2 diabetes mellitus was evaluated in more detail in a study of 194 Pima Indians who had GFR measured using iothalamate clearance . The following results were noted:
●In 31 patients with a normal glucose tolerance test, the mean GFR was 123 mL/min.
●In 29 patients with impaired glucose tolerance, the mean GFR was 135 mL/min.
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